MEDICARE: HEALTHTEXAS-DALLAS DIAGNOSTIC ASSOCIATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	00845W	TX
2	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	00845W	TX
3	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	00845W	TX
4	2084N0400X	Neurology Physician	00845W	TX
5	207N00000X	Dermatology Physician	00845W	TX
6	207RP1001X	Pulmonary Disease Physician	00845W	TX
7	207RR0500X	Rheumatology Physician	00845W	TX
8	207R00000X	Internal Medicine Physician	00845W	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00R87R	OTHER	TX	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245235886
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHTEXAS-DALLAS DIAGNOSTIC ASSOCIATION

Provider Business Mailing Address
First Line	:	8080 N CENTRAL EXPY
Second Line	:	STE 600, LB82
City	:	DALLAS
State	:	TX
Zip	:	75206-1838
Country	:	US
Telephone Number	:	972-860-8648
Fax Number	:	972-860-8679

Provider Business Practice Location Address
First Line	:	4708 ALLIANCE BLVD
Second Line	:	STE 300
City	:	PLANO
State	:	TX
Zip	:	75093-5339
Country	:	US
Telephone Number	:	972-758-6000
Fax Number	:	972-758-6001

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MRS. ELLEN ELIZABETH FOURTON
Credential	:
Telephone Number	:	972-860-8649

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	06/11/2010

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Directions to “HEALTHTEXAS-DALLAS DIAGNOSTIC ASSOCIATION ” Practice Location

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